ArticleStroke (Hoboken, N.J.)2026
Reporting and Analysis of Process-of-Care Time Measures for Hyperacute Stroke Interventions.
Article in Stroke (Hoboken, N.J.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundProcess-of-care time measures provide important information about hyperacute stroke interventions and performance of systems of care. These measures are often highly skewed, and mean-based summary statistics may be misleading. Percentile-based statistics (eg, median) conveniently and unbiasedly summarize the proportion of patients treated within a given timeframe. Despite this, mean-based synthesis methods are primarily recommended by the Cochrane Handbook for Systematic Reviews of Interventions for meta-analyses. We aim to investigate the reporting and statistical comparison of process-of-care time measures in published hyperacute stroke trials and systematic reviews of trials and provide methodological foundation for meta-analysis in future studies.
methodsA systematic scoping review of studies reporting or comparing time measures between events in the delivery of hyperacute stroke care was undertaken (Protocol DOI: 10.11124/JBIES-23-00136). Of 2321 studies identified through the database search, 146 studies were included. We analyzed the statistical agreement of transformation-based methods using process-of-care time data from hyperacute stroke clinical trials. We graphically and statistically compared mean- and percentile-based meta-analysis techniques for process-of-care time measures.
resultsOverall, 49 of 146 (34%) studies reported a process-of-care time measure using only the mean/SD. Under the normal distribution assumption, impossible (negative) time values would have been observed in 40 of 49 (82%) of those studies. Transformation-based imputation methods showed moderate agreement with the true SD (Lin Concordance Correlation Coefficient=0.88). Mean-based and median-based meta-analysis provided comparable results when analyzing summary measures of between-arm treatment effects and differed substantially when analyzing individual-arm summary measures.
conclusionsWe recommend that stroke researchers: (1) summarize a sufficient set of process-of-care time measures using the median/interquartile range and use consistent rank-based analysis methods; (2) exercise caution in utilizing transformation-based methods to impute the mean/SD of process-of-care time measures; and (3) use median-based meta-analytical techniques for the synthesis of process-of-care time measures.
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